FHI Assists Egypt to Increase Access to Voluntary Counseling and Testing Services

APRIL 2007 — Those at risk of HIV infection in Egypt now have access to critically needed voluntary counseling and testing services thanks to FHI's collaboration with the Ministry of Health and Population (MOHP), healthcare providers, NGOs, and religious leaders.

Working with these stakeholders, FHI is helping overcome two obstacles. First, until 2004, reporting of HIV/AIDS cases in Egypt was primarily based on mandatory testing of blood donors, foreigners, and nationals leaving to work abroad. Voluntary testing was available, but positive results were reported to the MOHP. Thus, many people avoided testing.

A second problem was stigma: HIV/AIDS was widely perceived as punishment for promiscuous behavior. So many healthcare providers declined to discuss methods of preventing sexual transmission of HIV.

FHI Leads Shift to Anonymous HIV Testing

FHI/Egypt has led the effort to convince the Egyptian government to shift from mandatory and reported HIV testing to anonymous testing. In 2002, FHI sponsored a consultative meeting in Cairo on establishing voluntary counseling and testing. The principal objective was to form a task force to coordinate voluntary counseling and testing under the umbrella of the National AIDS Program (NAP). The task force—comprising donors, implementing agencies, service providers, and others—helped partner organizations define their roles in establishing services in Egypt.

To ensure a standard approach, FHI worked with MOHP personnel to develop Arabic and English versions of the national voluntary counseling and testing guidelines and a national monitoring and evaluation plan for counseling and testing.

"The move to voluntary and anonymous testing conducted using standard procedures is significant," says FHI/Egypt Country Director Cherif Soliman. "People are less fearful of being tested, and when they know their HIV status they can take steps to protect themselves and their partners from infection."

A Possible Model for the Region

FHI established Egypt's first anonymous testing site in 2004 at the Central Laboratory in Cairo. Now eight USAID-funded, FHI-assisted sites are operating, and a ninth is expected to open soon. One of the sites—which FHI established in conjunction with Caritas Alexandria—is Egypt's first based at an NGO. In another first, voluntary counseling and testing and STI services have been integrated into one site in Sharm El Sheikh. Through February 2007, most clients have tested at either the Central Laboratory site (554) or Caritas Alexandria (258). FHI supported these centers and six others with electronic databases and materials, including brochures, posters, educational videos, training materials and guidelines. In addition, between August 2002 and December 2006 FHI trained 203 counselors.

FHI/Egypt has helped scale up similar services elsewhere in the region. For example, in 2006 FHI conducted a workshop in Cairo to introduce the principles of voluntary counseling and testing to 35 NAP and NGO representatives from 14 neighboring countries. Facilitators helped participants develop action plans for establishing and scaling up services, using the Egyptian program as a model. Following the workshop, FHI helped Yemen's NAP develop national guidelines and monitoring and evaluation plans and helped select the location of Yemen's first voluntary counseling and testing site. "We chose Yemen because it had an excellent action plan, motivated personnel, and demonstrated political commitment to establishing voluntary counseling and testing services," says Soliman, who hopes the Egyptian model can be extended throughout the region.

Remaining Challenges of Stigma, Fear, and Quality

Despite the successes, voluntary counseling and testing programs still face serious challenges in Egypt. Some people at high risk of HIV infection and who also engage in illegal practices—such as injecting drug use and sex work—fear using government services. This is one reason FHI/Egypt promotes anonymous testing and confidentiality of test results. Offering voluntary counseling and testing at sites providing integrated services also encourages access by reducing stigma.

Because client criticism of service quality also poses a challenge, FHI uses client feedback, refresher trainings and workshops for counselors to improve service quality.  In addition, FHI has increased technical support to sites, through regular site visits to enhance the monitoring of service delivery, analysis of client data and feedback and trouble-shooting, as needs arise.

Even so, the number of clients tested for HIV remains low. FHI/Egypt has made increasing use of voluntary counseling and testing services a high priority for 2007. In collaboration with other NGOs, the office is conducting seminars to educate those at highest risk. FHI has also conducted seminars for Christian and Muslim religious leaders to secure their support of prevention activities and train them to conduct educational sessions for their congregations. "It took a long time for NGOs and faith-based organizations to recognize the need to reach marginalized people," says Soliman, "but these community leaders have proven crucial in reducing stigma and attaining government support for national HIV/AIDS programs."

With that support and trust, FHI is developing a strategic plan for the MOHP to increase use of counseling and testing and STI services. "We are all in agreement," notes Soliman, "that these efforts are key to keeping HIV prevalence low in Egypt and preventing a more generalized epidemic."

PHOTOS: (home page) FHI/Egypt Country Director Cherif Soliman; (top) Muslim and Christian leaders particpate in an FHI-led workshop in 2005; (above) AIDS specialists from 14 Middle Eastern and North African countries participated in a regional training on HIV counseling and testing in Cairo in June 2006. The session was jointly organized by FHI and the World Health Organization.

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